Canadian students who applied (and got in) to American universities

[Inez_Only]

I'm a recent psychology undergrad student living in Manitoba applying for clinical psych programs this year, Dec. 2017 and was only considering applying to Canadian universities for grad school, but I'm now considering options in America as well. I was avoiding American schools because of higher tuition rates, being type 1 diabetic (Canada has great health care), having a partner who can't travel to the states, and now the recent political circumstances of the U.S. Have any other Canadian students moved to America for grad school and had difficulty (or ease) with the transition?

[TakeruK]

I am not in your field, but I am a Canadian student with a Canadian partner that moved to the US for a PhD program in 2012.

The transition is certainly a process but manageable. I'll be happy to discuss any specific questions you may have, either here, or in a PM if there are personal details. Most of my issues involve ensuring my spouse had the right to work in the US, which is only possible for me as a foreign student on J-1 status, whereas the typical foreign student status in the US is F-1. 

I'll address the two issues you present here first though:

1. The higher tuition rates does not directly affect us, assuming that your field fully funds graduate students (I think so, right?). Fully funded means that the department covers our tuition, higher rate and all, as well as pay us a stipend (whether the stipend is good or not depends though!). It does indirectly affects your chances to get in if you are applying to schools that charge higher tuition to international students (e.g. mostly public schools). At my school (a private one), tuition is over $40,000 per year for every student, but I don't see this charged anywhere (it gets charged directly to our advisors). Therefore, while being an international student decreases our admission chances at some schools, if you are admitted with a funding package, you don't have to worry about the higher tuition rate. In fact, at least in my field, in almost all cases, graduate students are paid better in the US than in Canada.

2. Health care: This is definitely a concern! When we first arrived, not all the provisions of the ACA (Affordable Care Act, aka Obamacare) had been in place yet, and my spouse was denied coverage due to a pre-existing condition. My spouse had to then get coverage as a dependent on my school program (school plan covers everyone regardless of conditions) but that costs $7200 per year (!!!). The school awarded us extra money to pay for this cost, fortunately. However, this no longer became a problem when ACA kicked in and my spouse was able to be covered through an open plan. Then, my spouse eventually found a good job that has very good coverage. (Note: a few years later, the other ACA provisions kicked in and did not allow insurance providers to charge a higher rate, $7200, for dependents compared to the primary insured ($2700 per year)).

For your specific case, I would still apply to US schools but look out for schools that actually provide you with health benefits. For example, the student coverage of my school's plan is great (the dependent coverage is great too but as I wrote above, potentially very expensive). Our plan costs $2700 per year, but the school pays $2200 per year and we pay only $500 per year. Overall, I actually spend less money and get more coverage in the United States than I did in Canada (in Ontario, OHIP is like $900 plus I paid $300 more for supplemental coverage). However, I don't have something like Type I diabetes.

Your actual cost due to maintaining your health could be quite high and I recommend that if you are considering offers from US schools, you should talk to other students with Type I diabetes when you visit! But, for now, I have some info on what is covered by my school's plans (again I think my school has one of the better plans available to students, so don't assume all schools do this level of coverage, make sure you check!):

The deductible per year is $150 (this means that you pay $150 first before some of the coverage starts).

The co-pay (what you pay) for most services is 20% (that is, if you see a specialist and the visit costs $300, you pay $60 and the insurance pays $240). However, the deductible is charged first.

The co-pay for most prescriptions is also 20%. Example: I have a nasal spray that costs $20. I pay $4 for each refill and the insurance covers $16. There's a caveat though: insurance providers are allowed to exclude certain medicines from coverage. Each year, they publish a new list of medicines and rank them as "Tier 1", "Tier 2", "Tier 3" and "Excluded". The higher the tier, the more restrictions there are on getting that drug covered. Most restrictions are things like you can only get X amount each time, or you must have the doctor get prior approval etc. The brand-name drugs are the ones that go on these Tier lists typically, as you are supposed to only get generic drugs unless there is no substitute or there is a special reason that you need the brand-name one. Note: for my plan, the deductible does not apply towards drug benefits.

The co-pay for a regular doctor's visit is special because the deductible doesn't apply. My plan's co-pay is $15, which means I pay $15 every time I visit the doctor and insurance covers the rest of the cost (usually a visit is about $60 to $100). If I get a test though (lab exam, x-ray, whatever), that counts as a separate thing and there's the deductible and 20% copay. 

There are two other important numbers to look for when comparing US health insurance plan. There is the annual out-of-pocket maximum. If your covered costs (i.e. copays and deductible) reach this number in one insurance year, your copay becomes $0 for the rest of the year and the insurance will pay for everything. My plan's out of pocket maximum is $1500. This means that no student on my plan should have to pay more than $2000 per year for health care ($500 for the premium, $1500 for the out of pocket max). In reality, some people still have to pay more because they need services that are not covered.

The last important number is something called Lifetime Maximum Benefit. This number is the most that the insurance company will ever pay for you in your life. Once you reach this number, you have to pay for everything yourself. This sounds terrible because it is terrible. Fortunately, it's so terrible that the ACA made it illegal for insurance companies to have this limit. So, right now, this must be "unlimited" by law. But I mention this because if the ACA is repealed, this law is also repealed so I don't know what the future will hold. Therefore, always check for this value when choosing plans.

To summarize, the values I quoted above, $150 deductible, $1500 max, $15 doctor visit, roughly 20% copay for everything else is usually known as a "Gold" or "Platinum" plan. Other plans "Silver", "Bronze" etc. cost twice and three times as much. (e.g. Silver is $30 doctor visit, 40% copay, deductible is $2000! and Bronze is $45 doctor visit, 60% copay, $4000 deductible etc.). Just to give you an estimate on the range of plans available. I remember that some schools have absolutely terrible plans and some don't even have prescription coverage.

All of the above is very generic and general and you'll have to determine the specifics for you when you have offers from US schools. I just wanted to give you a general idea. Basically, a lot of the horror stories we Canadians hear about the US system are true. ACA did fix some of them, but we have no idea what will happen next with that. In general, if you are well off and have a good job, you will mostly be fine within the US system. Sadly, a grad student with a livable stipend and a good student health plan is "well off" compared to the general US population---the ones really in trouble without ACA are people without the guarantee of insurance and/or a job. That said, because there are no longer any guarantees of future good healthcare laws due to Trump, I have no idea if this will be true in a year or two. No one knows.

[Inez_Only]

Thank you for the great and detailed response! After seeing and hearing about many of the rapid policy changes occurring in the U.S. right now, I'm only finding more and more reasons to apply exclusively across Canada.